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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Neurocognitive Dysfunction in Children, Adolescents, and Young Adults With CKD
Rebecca L Ruebner1, Nina Laney1, Ji Young Kim2
1Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Children with chronic kidney disease (CKD) show poorer neurocognitive function, especially in attention and memory. Lower estimated glomerular filtration rate (eGFR) and hypertension are linked to these cognitive deficits.
Area of Science:
- Pediatric Nephrology
- Neuroscience
- Clinical Research
Background:
- Neurocognitive dysfunction is a recognized complication in pediatric chronic kidney disease (CKD).
- Mechanisms and modifiable risk factors for cognitive impairment in CKD remain underexplored.
- This study aimed to identify risk factors for cognitive dysfunction in young individuals with CKD.
Purpose of the Study:
- To characterize neurocognitive function in children, adolescents, and young adults with CKD.
- To identify risk factors associated with cognitive deficits in this population.
- To compare neurocognitive performance in CKD patients against healthy controls.
Main Methods:
- A cross-sectional study design was employed.
- The Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults With Chronic Kidney Disease (NiCK) Study included 90 individuals with CKD and 70 controls, aged 8–25 years.
- Neurocognitive assessments were analyzed using linear regression, adjusting for estimated glomerular filtration rate (eGFR) and clinical variables; ambulatory blood pressure monitoring was also utilized.
Main Results:
- Individuals with CKD exhibited significantly poorer performance across multiple neurocognitive domains compared to controls.
- Deficits were particularly noted in attention, memory, and inhibitory control.
- Lower eGFR and indicators of hypertension (increased diastolic load, reduced nocturnal dipping) were independently associated with impaired neurocognitive performance.
Conclusions:
- Reduced eGFR in pediatric CKD patients is linked to diminished neurocognitive performance, affecting attention, memory, and inhibitory control.
- Hypertension, detected via ambulatory blood pressure monitoring, emerges as a potential risk factor.
- Neurocognitive function represents a target organ damage in CKD, highlighting the need for monitoring and intervention.
Background:
Neurocognitive dysfunction is a known complication in children with chronic kidney disease (CKD). However, less is known about putative mechanisms or modifiable risk factors. The objective of this study was to characterize and determine risk factors for cognitive dysfunction in children, adolescents, and young adults with CKD compared with controls.
Study Design:
Cross-sectional study.
Setting & Participants:
The Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults With Chronic Kidney Disease (NiCK) Study included 90 individuals aged 8 to 25 years with CKD compared with 70 controls.
Predictors:
CKD versus control, estimated glomerular filtration rate (eGFR), ambulatory blood pressure.
Outcomes:
Performance on neurocognitive assessment with relevant tests grouped into 11 domains defined a priori by expert opinion. Results of tests were converted to age-normalized z scores.
Measurements:
Each neurocognitive domain was analyzed through linear regression, adjusting for eGFR and demographic and clinical variables. For domains defined by multiple tests, the median z score of tests in that domain was used.
Results:
We found significantly poorer performance in multiple areas of neurocognitive function among individuals with CKD compared with controls. Particular deficits were seen in domains related to attention, memory, and inhibitory control. Adjusted for demographic and clinical factors, we found lower performance in multiple domains with decreasing eGFRs (attention: β=0.053, P=0.02; visual spatial: β=0.062, P=0.02; and visual working memory: β=0.069, P=0.04). Increased diastolic load and decreased diastolic nocturnal dipping on ambulatory blood pressure monitoring were independently associated with impairments in neurocognitive performance.
Limitations:
Unable to assess changes in neurocognitive function over time, and neurocognitive tests were grouped into predetermined neurocognitive domains.
Conclusions:
Lower eGFR in children, adolescents, and young adults is associated with poorer neurocognitive performance, particularly in areas of attention, memory, and inhibitory control. Hypertension identified on ambulatory blood pressure monitoring may be an important risk factor, illustrating that neurocognitive function is an area of target-organ damage in CKD.
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